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PMDD symptoms: What are the early signs of PMDD?

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist
Updated Oct. 27, 2023  •  Published Jun. 5, 2023
Fact Checked
PMDD symptoms: What are the early signs of PMDD?

Overview: What does PMDD feel like?

Premenstrual dysphoric disorder (PMDD) is a cluster of emotional, behavioral, and physical problems that occur one to two weeks before a woman’s menstrual period. Although it’s similar to premenstrual syndrome (PMS), PMDD symptoms are bad enough to cause emotional distress and interfere with work, school, relationships, and social activities. Depression, anxiety, rapid mood changes, tension, and irritability are common emotional issues that may occur, while decreased energy, loss of interest, appetite changes, sleep disturbances, and difficulty concentrating are common behavioral changes. Physical problems can also be hard to endure, including bloating, breast tenderness, painful joints, muscle aches, and weight gain. Because the cause of PMDD involves hormonal changes during the menstrual cycle, it can be experienced by anyone with ovaries during their reproductive years. PMDD is a serious women’s health issue–about 5% to 8% of women have it. If you add up all the symptomatic days, each woman with PMDD spends the equivalent of eight years of her life experiencing severe symptoms.

Key takeaways:

  • PMDD is a common health condition, primarily affecting women of reproductive age with ovaries. 

  • Early signs of PMDD can start any time after ovulation, up to a week or a few days before a woman’s period. The most common early signs of PMDD are irritability and anger.

  • Serious symptoms of PMDD, such as suicidal thoughts, may require immediate medical attention.

  • PMDD is caused by an increased sensitivity to progesterone and estrogen changes during the luteal phase of the menstrual cycle. There may be risks for developing PMDD symptoms, including a past traumatic experience, anxiety disorders, a high BMI, close family relatives with PMS, PMDD, mood disorders, or smoking.

  • PMDD usually requires a medical diagnosis.

  • PMDD generally requires treatment. PMDD symptoms sometimes resolve within days of treatment.

  • Treatment of PMDD may include lifestyle changes, dietary changes, SSRIs, antidepressants, or drugs that suppress ovulation, such as birth control pills. 

  • Untreated PMDD could result in complications, such as decreased quality of life, depression, and possibly suicide.

  • Use coupons for PMDD treatments, such as Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine), to save up to 80%.

What are the early signs of PMDD?

PMDD symptoms can appear right after ovulation when progesterone levels in the body begin to change. However, some women may not experience symptoms until a week or a few days before menses. The symptoms typically improve a few days after the onset of menses and go away entirely at the end of a woman’s period.

There’s a lot of fluctuation in women’s experience of PMDD symptoms, so the earliest signs of PMDD can vary. According to one study, the most common symptoms and earliest signs of PMDD are typically irritability and anger. 

RELATED: Ovulation 101: Learn more about cycles, calculators, and conception

Other PMDD symptoms

What are the early signs of PMDD?

Healthcare professionals often group PMDD symptoms into three categories: mood, behavior, and somatic (body-related).

Mood symptoms of PMDD include:

  • Depression or sadness

  • Sudden mood swings

  • Increased irritability or anger

  • Increased anxiety or tension

Behavioral symptoms of PMDD include:

  • Loss of interest in normal daily activities

  • Feeling like it’s hard to concentrate

  • Decreased energy and easily tiring out

  • Appetite changes, including overeating or food cravings

  • Sleeping too much

  • Being unable to sleep

  • Feeling overwhelmed

Physical symptoms of PMDD include:

  • Breast swelling

  • Breast tenderness

  • Joint pain

  • Muscle pain

  • Bloating

  • Weight gain

PMDD vs. PMS symptoms

PMDD is a more severe version of PMS. PMDD is more debilitating, more distressing, and interferes with daily life more than PMS. A diagnosis of PMS requires only one symptom to be experienced in the week before a period, whereas PMDD is diagnosed when there are a minimum of five symptoms. 

Additionally, PMS is diagnosed based on gynecological guidelines, so the focus is as much on physical symptoms as it is on functional or emotional symptoms. PMDD is a psychiatric diagnosis based on the DSM-V, a set of psychiatric diagnostic guidelines. A PMDD diagnosis is overwhelmingly based on mood, emotions, and behavior. Physical symptoms make up a much smaller part of the diagnosis. 

Diagnosis PMDD PMS
Criteria
  • Five symptoms must be present
  • Symptoms cause significant distress or interfere with work, school, activities, or social relationships
  • One symptom must be present
  • Symptoms cause dysfunction at work, school, or in social relationships
Symptoms
  • Mood swings
  • Irritability or anger
  • Depression
  • Anxiety or tension
  • Decreased interest in daily activities
  • Difficulty concentrating
  • Lack of energy or lethargy
  • Change in appetite
  • Hypersomnia or insomnia
  • Feeling overwhelmed
  • One or more physical symptoms
  • Angry outbursts
  • Anxiety
  • Confusion
  • Depression
  • Irritability
  • Social withdrawal
  • Abdominal bloating
  • Breast tenderness
  • Headache
  • Joint or muscle pain
  • Swelling of the feet, ankles, or hands
  • Weight gain

RELATED: What you should know about the impact of hormones on women’s health

When to see a doctor for PMDD symptoms

See a healthcare provider, gynecologist, or mental health professional if symptoms of PMS or PMDD are experienced, particularly if these symptoms are causing distress or are significantly affecting daily life.

The diagnosis will mainly involve a physical examination and medical history. The provider will be particularly interested in the severity, timing, and type of the symptoms experienced. A screening questionnaire, such as the Premenstrual Symptoms Screening Tool (PSST), may be given to rate the severity of symptoms.

It’s easy to misdiagnose PMDD. It’s often confused with mood disorders, such as major depressive or anxiety disorders, but it can also be mistaken as personality disorders or bipolar disorder. PMDD differs from other mental health conditions because the timing of the symptoms are synced to the menstrual cycle. To determine this, the clinician will suggest tracking and recording symptoms daily for two menstrual cycles. This can be done with a log or diary, but there are tools the clinician can offer. These include:

Complications of PMDD

Untreated PMDD can lead to job dysfunction, relationship problems, career snags, and other significant issues that affect happiness, quality of life, and security. Untreated PMDD can also lead to depression and even suicide.

How to treat PMDD symptoms

Because PMDD reduces the quality of life and affects relationships and careers, people with PMDD should seek treatment. There are several effective treatment options ranging from lifestyle changes to drug therapies.

Lifestyle changes 

Lifestyle changes can’t cure PMDD, but they can help reduce the severity of symptoms and their impact on daily life. They are usually the first treatment that healthcare providers utilize when treating PMDD. These lifestyle modifications include:

Antidepressants 

Antidepressants are often the first medication choice for controlling PMDD symptoms. These drugs affect a chemical in the brain called serotonin, which helps people regulate mood. The most commonly used are selective serotonin reuptake inhibitors (SSRIs). Although SSRIs typically take weeks or months to start improving symptoms of depression or anxiety, they only take one or two days to begin relieving symptoms of PMDD. Symptoms of PMDD get better in 70% of women who are treated with SSRIs.

Oral contraceptives or hormone therapy

A clinician may use drugs that suppress ovulation to control PMDD symptoms. The most commonly used medications for suppressing ovulation are oral contraceptives, but a healthcare provider may use hormone therapy or the drug danazol in more severe cases. Unfortunately, birth control pills may worsen some of the emotional symptoms. They also have side effects that may be harder to take than the side effects of SSRIs.

Benzodiazepines

Women who experience severe anxiety before their menstrual period may be given benzodiazepines or buspirone. 

NSAIDs

The physical symptoms of PMDD are often treated with over-the-counter NSAIDs, such as ibuprofen, or drugs to reduce menstrual flow and cramping.

RELATED: 12 ways to get rid of period cramps

Living with PMDD 

PMDD is not curable. The symptoms can be relieved or reduced with treatment. Still, lifestyle changes play a significant role in controlling the effects of PMDD:

  • Take all medications as instructed

  • Keep a daily log of symptoms and mood

  • Talk to a therapist if mood or other problems are an issue at other times of the month

  • Manage stress through relaxation techniques, meditation, deep breathing, or yoga

  • Exercise regularly

  • Increase the amount of slow-burning fuels, such as proteins or complex carbohydrates

  • Avoid caffeine and other stimulants

  • Increase calcium and vitamin B6 intake

  • Reduce salt intake to reduce fluid retention

  • Consider taking magnesium to also help reduce fluid retention and bloating

  • Get enough sleep by practicing good sleep hygiene

RELATED: How I identified—and live with—premenstrual dysphoric disorder (PMDD)

Most importantly, see a doctor

PMDD significantly, and sometimes severely, affects a woman’s life. Consider this: when all the days a woman spends living with PMDD are added, the average woman with PMDD spends eight years of her life with severe symptoms. That’s a lot, particularly considering treatment might reduce or relieve those symptoms. See a healthcare provider if premenstrual symptoms are burdensome, debilitating, or interfering with daily life. Though PMDD can’t be cured, PMDD treatments do work.

FAQs about PMDD symptoms

When are PMDD symptoms the worst?

PMDD symptoms are different in each woman. The symptoms can begin any time after ovulation and typically last until a few days after the menstrual period has started. Some cycles will be worse than others. Some days will be worse than others. The only way to know when the worst symptoms are experienced is to keep a daily log of symptoms and their severity to know what to expect.

Do PMDD symptoms get worse with age?

Premenstrual symptoms worsen as women approach menopause in their 40s, but this may vary among women.

How long do PMDD symptoms last?

PMDD symptoms can start after ovulation when hormone levels change and last until menses or a few days later. Some women experience premenstrual symptoms throughout this entire period. Others begin experiencing symptoms in the week before menses. Symptoms improve when the period starts and go away in the week following the period.

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What’s next? Additional resources for people with PMDD symptoms

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist

Josephine Bawab, Pharm.D., graduated from Virginia Commonwealth University School of Pharmacy. She began working in community pharmacy in 2012 and has worked for multiple chain pharmacies since then. She is passionate about helping patients and precepting students. She currently works and resides in Virginia, where she is just a few minutes away from the beach.

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